Author: Dochez, Vincent ; Riche, Valéry-Pierre ; Vigoureux, Solène ; Schirr-Bonnans, Solène ; Chabernaud, Camille ; Winer, Norbert ; Thubert, Thibault

Anti-D alloimmunization in the first trimester of pregnancy has long been the subject of prevention with anti-D immunoglobulins during events at risk of fetomaternal hemorrhage. Although the efficacy of preventing anti-D alloimmunization by an injection of immunoglobulin at 28 weeks of gestation (WG) is obvious, the literature provides little evidence of the effectiveness before 12⁺⁶ WG and several countries have modified their recommendations. In the presumed absence of a difference in alloimmunization risk between early and late prevention, our objective was to evaluate and compare the cost of treatment for 3 alloimmunization prevention strategies in France, the United Kingdom, and the Netherlands. This was a single-center retrospective study. Our target population included all women who received anti-D immunoglobulins (Rhophylac) in the first trimester of pregnancy before 12⁺⁶ WG at Nantes University Hospital in 2018 (N = 356). Within the target population, 2 other populations were constituted based on British (N = 145) and Dutch (N = 142) clinical practice guidelines (CPG). These 3 populations were analyzed for the comparative cost of treatment for prevention from a health system perspective. The average cost of Rhophylac alloimmunization prevention for 1 episode was €117.8 from a health system perspective. The total cost attributed to prevention in 2018 at Nantes University Hospital (N = 356) was €41,931.4 according to this perspective. If the UK CPG or Dutch CPG had been applied to the Nantes target population, a saving of around 60% would have been achieved. At the national level, the cost according to the health system perspective specifically attributable to induced abortion (N estimated = 26,916) could represent a total cost of €3,170,704. This study highlighted the high cost of the French prevention strategy in the first trimester of pregnancy compared with British or Dutch strategies. The modification of our practices would allow substantial financial savings to the French health system but would also avoid the nonrecommended exposure to a blood product at this term, would allow a faster medical management and a relief of the care system.

01 Jan 2010·Journal of Clinical ApheresisQ4 · MEDICINE

Prevention of Rh sensitization in the context of trauma: Two case reports

Q4 · MEDICINE

Article

Author: Werch, Jochewed B

AbstractBackground:Transfusion of D+ red blood cells (RBCs) to D− recipients can be accidental or necessary due to D− RBC shortage. Alloimmunization can complicate future transfusions; implications for women of childbearing age are compounded by possible hemolytic disease of the fetus and newborn. Rh immunoprophylaxis is effective, and indicated, for preventing alloimmunization. Reports of massive D+ mismatch (e.g., in the case of fetal‐maternal bleed) are limited, and standard recommendations for managing these rare events are lacking. The cases discussed herein of women of childbearing age who suffered severe trauma requiring emergency surgery illustrate the dilemma of determining the ideal strategy for Rh immunoprophylaxis.Case reports:The first patient received two units of mismatched RBCs and was treated with intravenous Rh immune globulin (IV RHIG; Rhophylac®, CSL Behring, Kankakee, IL) monotherapy beginning 49 h postsurgery. For the second patient, who received three units of D+ RBCs, partial RBC exchange transfusion, followed 48 h later by IV RHIG, was deemed appropriate based on the large volume of RHIG needed and concerns of hemolytic transfusion reaction and hyperbilirubinemia. Both patients recovered in full without further intervention; the first patient delivered a healthy child ∼11 months posttreatment.Conclusions:Rh immunoprophylaxis is effective, and indicated, for preventing alloimmunization in women of childbearing age to protect the mother, fetus, and newborn. For the general population, a case‐by‐case approach is recommended. The availability of IV RHIG improves patient safety by facilitating the delivery of such treatment. RBC exchange should be considered for large volume mismatches. J. Clin. Apheresis, 2010. © 2009 Wiley‐Liss, Inc.

01 Apr 2008·British Journal of HaematologyQ2 · MEDICINE

A human anti‐D monoclonal antibody selected for enhanced FcγRIII engagement clears RhD⁺ autologous red cells in human volunteers as efficiently as polyclonal anti‐D antibodies

Q2 · MEDICINE

Article

Author: Jean-Luc Teillaud ; Dominique Notelet ; Christophe de Romeuf ; Jean-François Prost ; Eric Guemas ; Roland Beliard ; Dominique Bourel ; Léna Massad ; Wouter Haazen ; Frédéric Dhainaut ; Tony Waegemans

SummaryA human anti‐RhD immunoglobulin G1 monoclonal antibody (mAb), R297, was tested in a phase I study to assess its ability to induce the clearance of antibody‐coated autologous RhD+ red blood cells (RBCs) in healthy male volunteers. The clearance potency of R297 was compared with that of a marketed human polyclonal anti‐D product (Rhophylac®). This mAb has been selected for its ability to strongly engage Fc‐gamma receptor IIIA and to mediate a potent antibody‐dependent cell cytotoxicity (ADCC) against RhD+ RBCs. Autologous RhD+ RBCs were sensitized with either Rhophylac® or R297 at three different coating percentages (25, 12·5 and 6·25%), before re‐infusion. This phase I study showed that the human R297 mAb promoted rapid and complete clearance of RBCs, and showed activity that was at least as potent as the human polyclonal anti‐D antibody preparation. Clearance of RBCs could still be observed when the percentage of R297 used to coat the RBCs was reduced to 6·25%. Finally, none of the adverse events was severe or considered to be related to R297. Thus, R297 is a promising candidate for the prevention of allo‐immunization and represents a new generation of Fc‐modified monoclonal antibodies with increased FcγRIII binding and increased ADCC.

100 Deals associated with Rho(D) Immune Globulin Intravenous (Human)(CSL Behring)

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Indication	Country/Location	Organization	Date
Purpura, Thrombocytopenic, Idiopathic	US	CSL Behring AG	12 Feb 2004
Transfusion Reaction	US	CSL Behring AG	12 Feb 2004

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